Nonprescription bronchodilator use in asthma

Safety of ephedra and related anorexic medications

BACKGROUND

The increasing incidence of obesity, anorexia and bulimia has resulted in an increased interest in anorexic medications that can modify human eating behaviors. History and medical research is replete with consequences of addressing behavioral disorders with pharmacologic approaches to intervention in the absence of cognitive therapies such as self-efficacy counseling, which we and others have shown to be extremely effective at modifying behaviors previously thought to be resistant to such treatment. This paper looks at some of the ramifications of using anorexic medications, including ephedra, in modern society's efforts to address weight-related health problems.

METHODS

A review of the medical literature about ephedra and related anorexic medications was undertaken as they are linked to eating disorders. The findings included limited evidence of clinical benefit from such medications with concerns over side effects such as cardiovascular, gastrointestinal, CNS and other potential problems. We provide information about current recommendations for using these medications along with concerns for their use.

CONCLUSION

This paper is a review of ephedra and similar anorexic medications and nonprescription substances used in the treatment of obesity and other eating disorders along with some of the potential and proven consequences of such treatment.

Don't ask, don't tell: parental nondisclosure of complementary and alternative medicine and over-the-counter medication use in children's asthma management

INTRODUCTION

Parent-health care provider (HCP) communication is an important component of pediatric asthma management. Given the high prevalence of complementary and alternative medicine (CAM) and over-the-counter (OTC) medication use among this population, it is important to examine parental nondisclosure of these asthma management strategies.

METHOD

One-time interview and 1-year retrospective medical record review with 228 parents of 5- to 12-year-old children with asthma enrolled from six pediatric primary care practices examining parental nondisclosure of CAM and OTC medication use, reasons for nondisclosure, medical record documentation of CAM usage, and association between parent-HCP relationship and nondisclosure.

RESULTS

Seventy-one percent of parents reported using CAM and/or OTC medication for children's asthma management, and 54% of those parents did not disclose usage. Seventy-five percent "did not think" to discuss it. Better parent-HCP relationship led to decreased nondisclosure.

DISCUSSION

HCPs can play an important role in creating an environment where parents feel comfortable sharing information about their children's asthma management strategies in order to arrive at a shared asthma management plan for the child, leading to improved asthma health outcomes.

Safety of over-the-counter inhalers for asthma: report of the council on scientific affairs

The occasional use of over-the-counter (OTC) epinephrine inhalers appears to be safe and effective when used according to labeled instruction by individuals with mild, intermittent asthma. However, gross misuse of these products can cause severe adverse reactions, including death. Limited survey data suggest that approximately 20% of individuals using OTC epinephrine inhalers have mild-to-moderate persistent asthma. According to recent consensus guidelines, these individuals should be under a physician's care and receiving corticosteroid therapy. If these products continue to be marketed, labeling should be strengthened to better educate users about appropriate and inappropriate use of OTC epinephrine inhalers intended for patients with mild, intermittent asthma.